Retrosternal, Forgotten, and Recurrent Goiter

Terms such as retrosternal, substernal, and intrathoracic have been used to define an extension of >50% of the thyroid gland beyond the thoracic inlet. The reported incidence of retrosternal goiters is highly variable, ranging from 1% to 45% of thyroidectomies in studies with different defining criteria. Forgotten goiter lacks any parenchymatous or vascular connection with the cervical thyroid and may represent remnants of a partially resected cervical goiter or perhaps the result of a separate and autonomously functioning thyroid tissue that becomes hypertrophic after the removal of the cervical gland. A recurrent goiter is the regrowth of thyroid tissues after thyroidectomy for benign disease or malignancy of the thyroid. Computed tomography and/or magnetic resonance imaging are essential in surgical decision-making for retrosternal goiters, since they provide a clear definition of the multidimensional size and of the morphology of the disease, defining the relevant and at-risk anatomical structures. Total thyroidectomy represents the treatment of choice for retrosternal goiters, and reoperative thyroid surgery should be performed in case of symptomatic recurrent or forgotten goiter, in case of suspected malignancy or in some cases of recurrent thyrotoxicosis; the surgery is achieved through a cervical or extracervical approach, which requires multidisciplinary collaboration.